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Stellato M, Buti S, Maruzzo M, Bassanelli M, Bersanelli M, Napoli MD, Dionese M, Fanelli M, Filippi R, Fotia G, Galli L, Grillone F, Maffezzoli M, Maiorano BA, Nasso C, Rebuzzi SE, Lalli L, Roviello G, Sorarù M, Vincenzi B, Procopio G, Verzoni E. Real World Analysis of Peritoneal Metastasis From Renal Cell Carcinoma. Meet-Uro27. Clin Genitourin Cancer 2024; 22:102078. [PMID: 38631104 DOI: 10.1016/j.clgc.2024.102078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Peritoneal metastases (PM) have been reported in approximately 1% of patients with metastatic Renal Cell Carcinoma (mRCC). Outcome data are limited due to the rarity of this metastatic site. Therefore, the aim of our study is to describe renal cell carcinoma (RCC) patients with PM treated as per clinical practice. MATERIALS AND METHODS Baseline characteristics and outcome data of patients with PM from RCC were retrospectively collected from 18 Italian oncological referral centers adhering to the Meet-Uro group, from January 2016 to January 2023. RESULTS We collect 81 RCC patients with PM. 78/81 received systemic treatment, 3/81 only best supportive care. First line treatment included tyrosine-kinase inhibitors (TKI) (46/78), ImmuneOncology (IO)-TKI (26/78) and IO-IO (6/78), with different Objective Response Rate (ORR) (43.4% in TKI monotherapy group vs 50% in IO-TKI group, respectively) and Disease Control Rate (DCR) (60.8% in TKI treated patients vs. 76.9% in IO-TKI treated patients). Median PFS was 6.4 months (95%CI 4.18-14.8) in patients treated with TKI monotherapy vs 23.7 months (95%CI 11.1-NR) in patients treated with IO-TKI (p < 0.015). The median OS (mOS) was 22.7 months (95%CI 13.32 - 64.7) in the TKI monotherapy group vs 34.5 mo (95%CI NR-NR) in the IO-TKI group with 53.8% of patients alive at 1 years in the latter group, (p < 0.16). Primary refractory patients were 36.9% for TKI and 15.3% for IO-TKI. According to International Metastatic renal cell carcinoma Database Consortium (IMDC) score, mPFS and mOS were consistent among risk categories. Median PFS was 36.6 months (95%CI 10.9-NR) for good risk patients compared to 10 months (95%CI 7.5-29.8) for intermediate risk and 2.96 months (95%CI 2.43-11.28) for poor risk population (p < 0.0005) whereas mOS was NR (95%CI 28.65-NR) for good risk patients compared to 35.3 months (95%CI 24.6-NA) and 12.4 months (95%CI 3.52-NR) for intermediate and poor risk population, respectively, (p < 0.0002). Only 34/78 (43.5%) received a second line treatment that was TKI (ORR 8.3% and DCR 41.6%) or IO (ORR 18.1% and DCR 40.9%). CONCLUSION We report one of the largest case series regarding PM from RCC. Characteristics of patients suggest a more aggressive behavior of PM from mRCC. Outcome data suggest that TKI-IO as first line treatment, and TKI as second line, confirm their activity for these patients with dismal prognosis.
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Affiliation(s)
- Marco Stellato
- Genitourinary Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy.
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Marco Maruzzo
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Maria Bassanelli
- Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Marilena Di Napoli
- Department of Oncology, Fondazione IRCCS Istituto Nazionale Tumori "G. Pascale", Napoli, Italy
| | - Michele Dionese
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - Martina Fanelli
- Department of Oncology, University Hospital of Udine, Udine, Italy
| | | | - Giuseppe Fotia
- Genitourinary Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Galli
- Department of Surgical, Medical and Molecular Pathology and Critical Area Medicine, University of Pisa, Pisa, Italy
| | | | | | - Brigida Anna Maiorano
- Oncology Unit, Foundation Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Cecilia Nasso
- Medical Oncology, Ospedale Santa Corona, Pietra Ligure, Italy
| | - Sara Elena Rebuzzi
- Medical Oncology Unit, Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genoa, Genoa, Italy
| | - Luca Lalli
- Unit of Translational Immunology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Giandomenico Roviello
- Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy
| | - Mariella Sorarù
- Oncology Unit, Camposampiero General Hospital, Padova, Italy
| | - Bruno Vincenzi
- Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Giuseppe Procopio
- Genitourinary Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Verzoni
- Genitourinary Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Hu H, Lai S, Wang M, Tang X, Lai CH, Xu K, Xu T, Hu H. Effect of subsequent bladder cancer on survival in upper tract urothelial carcinoma patients post-radical nephroureterectomy: a systematic review and meta-analysis. BMC Urol 2023; 23:212. [PMID: 38129811 PMCID: PMC10734187 DOI: 10.1186/s12894-023-01387-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Radical nephroureterectomy (RNU) is the primary treatment strategy for upper tract urothelial carcinoma (UTUC). However, the intravesical recurrence occurs in 20-50% of all patients. The specific effect of subsequent bladder cancer (SBCa) on survival remains unclear. Therefore, we investigated the effect of SBCa following RNU in patients with UTUC. METHODS PubMed, EMBASE, and Cochrane Library were exhaustively searched for studies comparing oncological outcomes between SBCa and without SBCa. Standard cumulative analyses using hazard ratios (HR) with 95% confidence intervals (CI) were performed using Review Manager (version 5.3). RESULTS Five studies involving 2057 patients were selected according to the predefined eligibility criteria. Meta-analysis of cancer-specific survival (CSS) and overall survival (OS) revealed no significant differences between the SBCa and non-SBCa groups. However, subgroup analysis of pT0-3N0M0 patients suggested that people with SBCa had worse CSS (HR = 5.13, 95%CI 2.39-10.98, p < 0.0001) and OS (HR = 4.00, 95%CI 2.19-7.31, p < 0.00001). CONCLUSIONS SBCa appears to be associated with worse OS in patients with early stage UTUC. However, caution must be taken before recommendations are made because this interpretation is based on very few clinical studies and a small sample size. Research sharing more detailed surgical site descriptions, as well as enhanced outcome data collection and improved reporting, is required to further investigate these nuances.
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Affiliation(s)
- Haopu Hu
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Shicong Lai
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Mingrui Wang
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Xinwei Tang
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Chin-Hui Lai
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Kexin Xu
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Tao Xu
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Hao Hu
- Department of Urology, Peking University People's Hospital, Beijing, China.
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3
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Isgrò G, Rogers A, Veeratterapillay R, Rix D, Page T, Maestroni U, Bertolotti L, Pagnini F, Martini C, De Filippo M, Ziglioli F. Role of Renal Biopsy in the Management of Renal Cancer: Concordance between Ultrasound/CT-Guided Biopsy Results and Definitive Pathology, Adverse Events, and Complication Rate. J Clin Med 2023; 13:31. [PMID: 38202038 PMCID: PMC10779766 DOI: 10.3390/jcm13010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: In the last decade, the number of detected renal cancer cases has increased, with the highest incidence in Western countries. Although renal biopsy is reported as a safe procedure, it is not adopted in all centres. As it is not possible to accurately distinguish benign tumours using imaging, this may lead to overtreatment. Most of the cancer detected on imaging is treated by surgery, radiofrequency ablation (RFA), or cryotherapy. (2) Methods: This was a single-centre retrospective study of 225 patients studied preoperatively with ultrasound (US)/CT-guided renal biopsy, with the aim of supporting clinical management. Decisions regarding the biopsy were based on either MDT indication or physician preference. US-guided renal biopsy was the first option for all patients; CT-guided biopsy was used when US-guided biopsy was not feasible. The efficacy of renal biopsy in terms of diagnostic performance and the concordance between biopsy results and definitive pathology were investigated. Additionally, adverse events related to the biopsy were recorded and analysed. Data collected throughout the study were analysed using binary logistic regression, Fisher's exact test, and Pearson's chi-square test to investigate possible correlations between post-procedural complications and the size of the lesion. (3) Results: Renal biopsy was not diagnostic in 23/225 (10.2%) patients. A CT-guided approach was necessary in 20/225 patients after failure of US-guided biopsy. The complication rate of renal biopsy was 4.8% overall-all Clavien grade I and without any serious sequelae. Interestingly, complications occurred in patients with very different sizes of renal cell carcinoma. No correlation between complications and anticoagulant/antiplatelet drugs was found. No seeding was reported among the patients who underwent partial/radical nephrectomy. (4) Conclusions: Renal biopsy was shown to be safe and effective, with a high concordance between biopsy results and definitive pathology and a low rate of complications. The use of a CT-guided approach whenever the US-guided approach failed improved the diagnostic performance of renal biopsy.
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Affiliation(s)
- Gianmarco Isgrò
- Department of Urology, James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - Alistair Rogers
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK (R.V.)
| | - Rajan Veeratterapillay
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK (R.V.)
| | - David Rix
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK (R.V.)
| | - Toby Page
- Department of Urology, James Cook University Hospital, Middlesbrough TS4 3BW, UK
| | - Umberto Maestroni
- Department of Urology, University Hospital of Parma, 43100 Parma, Italy (F.Z.)
| | - Lorenzo Bertolotti
- Department of Medicine and Surgery, Section of Radiology, University-Hospital of Parma, 43100 Parma, Italy (M.D.F.)
| | - Francesco Pagnini
- Department of Medicine and Surgery, Section of Radiology, University-Hospital of Parma, 43100 Parma, Italy (M.D.F.)
| | - Chiara Martini
- Department of Medicine and Surgery, University-Hospital of Parma, 43100 Parma, Italy
| | - Massimo De Filippo
- Department of Medicine and Surgery, Section of Radiology, University-Hospital of Parma, 43100 Parma, Italy (M.D.F.)
| | - Francesco Ziglioli
- Department of Urology, University Hospital of Parma, 43100 Parma, Italy (F.Z.)
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Ohtsu A, Arai S, Fujizuka Y, Fukuda R, Hori K, Morimura Y, Kawahara R, Shiraishi T, Ogawa H, Miyazawa Y, Nomura M, Sekine Y, Koike H, Matsui H, Suzuki K. Retroperitoneal urothelial carcinoma arising after bladder diverticulectomy: a case report. BMC Urol 2023; 23:88. [PMID: 37165362 PMCID: PMC10173469 DOI: 10.1186/s12894-023-01266-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/03/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Urothelial carcinoma arises from the inner urothelial membrane of the renal pelvis, ureter, and bladder and often causes macrohematuria. Here, we report a rare case in which the patient developed non-symptomatic urothelial carcinoma anatomically outside the bladder wall 17 years after bladder diverticulectomy. CASE PRESENTATION An 82-year-old male patient previously underwent gastrectomy for stomach cancer and partial hepatectomy for intrahepatic cholangiocarcinoma. Follow-up computed tomography revealed a tumor in the retroperitoneal space, where a bladder diverticulum was removed 17 years earlier. Multiparametric magnetic resonance imaging suggested that the tumor was malignant with rectal invasion. Subsequent computed tomography-guided percutaneous biopsy revealed that the tumor was urothelial carcinoma. The patient underwent two courses of neoadjuvant chemotherapy followed by pelvic exenteration with pelvic lymph node dissection. He is currently receiving adjuvant therapy with an immune checkpoint inhibitor and has had no recurrence for 3 months. CONCLUSIONS Multiparametric magnetic resonance imaging is a helpful tool for predicting both tumor malignancy and invasion before a pathologically confirmed diagnosis. Although this case is rare, urologists should be aware of the occurrence of urothelial carcinoma after bladder diverticulectomy in cases of incomplete resection of the diverticulum.
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Affiliation(s)
- Akira Ohtsu
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Seiji Arai
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan.
| | - Yuji Fujizuka
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Reon Fukuda
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Keisuke Hori
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Yuki Morimura
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Rintaro Kawahara
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Takuya Shiraishi
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Hiroomi Ogawa
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Yoshiyuki Miyazawa
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Masashi Nomura
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Yoshitaka Sekine
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Hidekazu Koike
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Hiroshi Matsui
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
| | - Kazuhiro Suzuki
- Department of Urology, Gunma University Hospital, 3-39-15, Showa-Machi, Maebashi, Gunma, Japan
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Emerson R, Singh P, Parida GK, Kumar P, Agrawal K. Recurrent Renal Cell Carcinoma Presenting as Port-Site Metastases, Detected on 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography. Indian J Nucl Med 2023; 38:174-176. [PMID: 37456184 PMCID: PMC10348512 DOI: 10.4103/ijnm.ijnm_168_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/24/2022] [Indexed: 07/18/2023] Open
Abstract
The incidence of port-site metastases (PSMs) varies with the tumor type with adenocarcinoma having a high incidence. However, it is rarely seen in urological malignancies and more so in renal cell carcinoma (RCC). We hereby describe one such case of PSM after laparoscopic radical nephrectomy for RCC, which was detected on 18F-fluorodeoxyglucose positron emission tomography-computed tomography.
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Affiliation(s)
- Ralph Emerson
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Parneet Singh
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Girish Kumar Parida
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Pramit Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Kanhaiyalal Agrawal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Robot-Assisted Radical Cystectomy: A Single-Center Experience and a Narrative Review of Recent Evidence. Diagnostics (Basel) 2023; 13:diagnostics13040714. [PMID: 36832202 PMCID: PMC9955211 DOI: 10.3390/diagnostics13040714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 12/31/2022] [Accepted: 01/06/2023] [Indexed: 02/16/2023] Open
Abstract
Radical cystectomy represents one of the most challenging surgical procedures, exhibiting a high morbidity rate. The transition to minimally invasive surgery in the field has been steep, due to either the technical complexity and prior concerns of atypical recurrences and/or peritoneal spread. More recently, a larger series of RCTs has proven the oncological safety of robot-assisted radical cystectomy (RARC). Beyond survival outcomes, the comparison between RARC and open surgery in terms of peri-operative morbidity is still ongoing. We present a single-center experience of RARC with intracorporeal urinary diversion. Overall, 50% of patients had an intracorporeal neobladder reconstruction. The series confirms a low rate of complications (Clavien Dindo ≥ IIIa 7.5%) and wound infections (2.5%) and the absence of thromboembolic events. No atypical recurrences were found. To discuss these outcomes, we reviewed the literature related to RARC including level-1 evidence. PubMed and Web of Science searches were performed using the medical subject terms "robotic radical cystectomy" and "randomized controlled trial (RCT)". Six unique RCTs comparing robot and open surgery were found. Two clinical trials dealt with RARC with an intracorporeal reconstruction of UD. Pertinent clinical outcomes are summarized and discussed. In conclusion, RARC is a complex but feasible procedure. The transition from extracorporeal urinary diversion (UD) to a complete intracorporeal reconstruction could be the key to improving peri-operative outcomes and reducing the whole morbidity of the procedure.
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Rodríguez Fernández E, Cardo AL, Subirá Ríos D, Cancho Gil MJ, González García FJ, Herranz Amo F, Hernández Fernández C. Peritoneal carcinomatosis after partial nephrectomy for renal cell carcinoma: Our experience and literature review. Actas Urol Esp 2022; 46:481-486. [PMID: 36117081 DOI: 10.1016/j.acuroe.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/28/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Peritoneal carcinomatosis associated with renal cell carcinoma is an infrequent entity, usually associated with large renal masses, and with a very rare presentation after surgery of localized renal tumors. Our objective is to review the literature and analyze the factors involved in the development of peritoneal carcinomatosis after laparoscopic partial nephrectomy in localized tumors. MATERIAL AND METHODS We present our experience with two cases of peritoneal carcinomatosis after laparoscopic partial nephrectomy. We reviewed the literature and analyzed the factors associated with the development of peritoneal carcinomatosis after laparoscopic partial surgery in renal cell carcinoma. RESULTS Between 2005-2018, 225 patients underwent laparoscopic partial nephrectomy for localized renal neoplasia in our service. Two patients developed peritoneal carcinomatosis during follow-up, at 1.5 and 7 years after surgery. Few cases of postoperative peritoneal carcinomatosis for renal neoplasia have been described in the literature, being more frequently associated with large renal masses, with multiple metastases at diagnosis, with a poor prognosis. The dissemination of tumor cells during surgery, direct tumor extension or metastasis by hematogenous route, are among the factors involved in the development of this condition. CONCLUSIONS Peritoneal carcinomatosis after laparoscopic partial nephrectomy constitutes a very rare event. However, it should be taken into consideration, and, since it is the only factor we can influence, we must maximize precautions during the surgical act, following oncological principles.
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Affiliation(s)
- E Rodríguez Fernández
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - A L Cardo
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - D Subirá Ríos
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M J Cancho Gil
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F J González García
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F Herranz Amo
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - C Hernández Fernández
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Russo P, Blum KA, Weng S, Graafland N, Bex A. Outcomes for Atypical Tumor Recurrences Following Minimally Invasive Kidney Cancer Operations. EUR UROL SUPPL 2022; 40:125-132. [PMID: 35638088 PMCID: PMC9142748 DOI: 10.1016/j.euros.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 11/28/2022] Open
Abstract
Background We managed a cohort of patients treated with minimally invasive surgery (MIS) for a kidney tumor presenting with atypical tumor recurrence (ATR) involving port sites, intraperitoneal carcinomatosis, and nephrectomy bed/perinephric tumor implants. Objective To determine the clinical characteristics, management, and oncologic outcomes for patients with localized renal cell carcinoma (RCC) who develop ATR following curative-intent MIS for partial or radical nephrectomy. Design, setting, and participants The study cohort comprised patients from 1999 to 2021 with localized RCC managed at Memorial Sloan Kettering Cancer Center (New York, NY, USA) after MIS for partial or radical nephrectomy who developed ATR. Outcome measurements and statistical analysis: We collected data on clinicopathologic characteristics, treatments, time to ATR, and overall survival. Results and limitations The median age of the 58 RCC patients was 61 yr. Forty-one patients (71%) were male, 26 (45%) had robot-assisted operations, and 39 (67%) had clear cell RCC. Twenty-nine patients had stage pT1 disease (50%) and ten (17%) had positive surgical margins. The most common ATR site was perinephric/nephrectomy bed implants (n = 28, 48%). Management included: surgical resection alone (n = 11, 19%), systemic therapy alone (n = 12, 21%), surgical resection and systemic therapy (n = 17, 29%), and palliative care (n = 8, 14%). At median follow-up of 59 mo (interquartile range [IQR] 28–92), the median time to ATR was 12 mo (IQR 5–28). Overall survival at 5 yr was 69.0% (95% confidence interval 57.4–83.1%) with only nine patients alive with no evidence of disease. Limitations include the potential for referral, detection, and selection biases, as well as uncertainty regarding the true incidence of ATR. Conclusions ATR following MIS for partial or radical nephrectomy is an understudied, poor prognostic event which leads to a heavy treatment burden. Further investigation into its etiology and means of prevention is warranted. Patient summary Patients experiencing recurrence of kidney cancer in an atypical site require a heavy treatment burden and have a guarded overall prognosis. Continued research is needed to determine the precise incidence of these recurrences and identify methods for mitigating them.
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Rodríguez Fernández E, Cardo A, Subirá Ríos D, Cancho Gil M, González García F, Herranz Amo F, Hernández Fernández C. Carcinomatosis peritoneal tras nefrectomía parcial laparoscópica en carcinoma de células renales: nuestra experiencia y revisión de la literatura. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mally D, Pfister D, Heidenreich A, Albers P, Niegisch G. [Does robotic radical cystectomy affect oncological outcomes in bladder cancer patients?]. Aktuelle Urol 2022; 53:153-158. [PMID: 35345013 DOI: 10.1055/a-1745-8521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Robot-assisted surgery in urology is now being used in a wide range of procedures. In addition to reconstructive procedures, tumour surgery such as radical cystectomy is of particular importance. While studies on the perioperative quality of robotic-assisted radical cystectomy suggest a favorable impact on morbidity (and thus mortality), the question remains as to what extent the oncological quality is influenced by this procedure in terms of recurrence-free and overall survival.In this context, following a comprehensive literature review, this paper presents data from retrospective cohort comparisons of open and robotic cystectomy, registry data and single centre series on robotic and open cystectomy, and the results of prospective randomised trials.In summary, from an oncological point of view, robotic cystectomy is not inferior to open cystectomy. Overall survival, cancer-specific survival, and progression-free survival data do not differ in retrospective cohort studies, in indirect comparisons of registry data and/or large series, or in prospective studies to date. With regard to the occurrence of atypical metastases after robotic cystectomy, prospective data are currently lacking and retrospective analysis produce conflicting data. However, general oncological outcome seems not to be affected.Thus, robotic-assisted cystectomy is also from an oncological point of view a good option for patients who have an indication for radical cystectomy.
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Affiliation(s)
- David Mally
- Klinik für Urologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - David Pfister
- Klinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln, Köln, Germany
| | - Axel Heidenreich
- Klinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln, Köln, Germany
| | - Peter Albers
- Klinik für Urologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Günter Niegisch
- Klinik für Urologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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11
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Morselli S, Vitelli FD, Verrini G, Sebastianelli A, Campi R, Liaci A, Spatafora P, Barzaghi P, Ferrari G, Gacci M, Serni S, Brausi M. Comparison of Tumor Seeding and Recurrence Rate After Laparoscopic vs. Open Nephroureterectomy for Upper Urinary Tract Transitional Cell Carcinoma. Front Surg 2022; 8:769527. [PMID: 35004836 PMCID: PMC8732869 DOI: 10.3389/fsurg.2021.769527] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Laparoscopic surgery for Upper Urinary Tract Urothelial Cell Carcinoma (UTUC) is still debated for its possible seeding risk and thus consequent oncological recurrences, especially for atypical ones. The aim of the study is to compare recurrence and survival after Laparoscopic vs. Open Radical Nephroureterectomy (RNU) for Upper Urinary Tract Urothelial Cancer (UTUC). Method: A retrospective evaluation of UTUC consecutive surgeries from 2008 to 2019 was conducted, including pT ≥ 2, High Grade UTUC who underwent RNU with bladder cuff excision without concomitant lymphadenectomy in three urological tertiary centers. Statistical analyses compared recurrence and cancer specific survival, based on surgical approach, while logistic multivariate analyses and Kaplan Meyer survival curve analyzed possible risk factors for recurrence and survival. Results: One hundred seven cases of RNU, 47 (43.9%) laparoscopic and 60 (56.1%) open, were included in this report. Preoperative characteristics were comparable between groups. However, tumor stage was higher in the Open arm [T3–T4 in 44 (73.3%) vs. 20 (43.4%) in Laparoscopic]. Mean follow-up was 91.6 months in laparoscopy RNU vs. 93.5 months in open RNU. Recurrence rate (RR) was comparable between groups (p = 0.594), and so was the site, although 3 (6.3%) peritoneal recurrences were found only in laparoscopic group (p = 0.057). At multivariate logistic regression, tumor stage and surgical approach were independent predictors of recurrence (p < 0.05), while only tumor stage was predictor of cancer specific death (p = 0.029). Conclusion: Surgical approach has no impact on recurrence site, overall survival, and RR. Still, according to our data peritoneal carcinomatosis was present only in laparoscopic arm, despite how it didn't reach statistical significance.
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Affiliation(s)
- Simone Morselli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | | | | | - Arcangelo Sebastianelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Campi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Liaci
- Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Pietro Spatafora
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Barzaghi
- Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Mauro Gacci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Minimally Invasive Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Maurizio Brausi
- Department of Urology, Cure Hesperia Hospital, Modena, Italy.,Department of Urology, AUSL Modena, Modena, Italy
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12
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Gallioli A, De Lorenzis E, Lievore E, Boeri L, Colombo L, Fontana M, Breda A, Montanari E, Albo G. The effect of CO2 pressure and flow variation on carbon particles spread during pneumoperitoneum: an experimental study. J Endourol 2021; 36:807-813. [PMID: 34779236 DOI: 10.1089/end.2021.0336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A correlation between atypical recurrences and minimally-invasive surgery has been suggested in case of urothelial cancer; however, very few data are available on the role of pneumo peritoneum in terms of gas flow and intra-abdominal pressure. The objective of the study is to analyze the impact of CO2 pneumoperitoneum variation on an inert material as surrogate of neoplastic cells. MATERIAL AND METHODS We designed an experimental model mimicking pneumoperitoneum in three settings: sealed flow (no leakage), pulsatile flow (alternating efflux and influx) and continuous flow (AirSeal® insufflator). Each experiment was characterized by a pre-determined gas flow and pressure, trocar distance and position from the particles. Hounsfield density (HD) variation in the areas of interest was measured as index of graphite powder dispersion. A Linear regression model was employed to measure the correlation between modifiable variables and HD. RESULTS HD was lower in the pulsatile compared to both the sealed and continuous flows (p < 0.03). On multivariate analysis for sealed setting, flow and total gas liters delivered (i.e. gas leakage) were inversely and independently related to HD (all p <0.03). In pulsatile setting, trocar position, trocar distance and gas flow independently predicted HD (all p <0.03). In continuous setting, gas pressure was directly and independently related to HD (p = 0.004) due to decreased pneumoperitoneum stability and increased CO2 liters delivered. In case of in-flow trocar positioned laterally to the particles, low flow (1 L/min) or low pressure (8 mmHg), HD values recorded in the three settings were all overlapping (all p > 0.05). CONCLUSIONS Flow and pressure setting, in-flow trocar distance and contiguity from the tumor, and pneumoperitoneum stability may be all crucial component in minimally invasive surgery. In vivo, these variables should be considered as potential risk factors for tumor cells spread within the abdominal cavity.
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Affiliation(s)
- Andrea Gallioli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy.,Fundacio Puigvert, 16444, Urology, Barcelona, Catalunya, Spain;
| | - Elisa De Lorenzis
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy.,Università degli Studi di Milano, 9304, Department of Clinical Sciences and Community Health, Milano, Lombardia, Italy;
| | - Elena Lievore
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy;
| | - Luca Boeri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy.,Università degli Studi di Milano, 9304, Department of Clinical Sciences and Community Health, Milano, Lombardia, Italy;
| | - Lorenzo Colombo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy;
| | - Matteo Fontana
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy;
| | - Alberto Breda
- Fundació Puigvert, 16444, Urology, Barcelona, Catalunya, Spain;
| | - Emanuele Montanari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 9339, Urology, Milan, Lombardia, Italy.,Università degli Studi di Milano, 9304, Department of Clinical Sciences and Community Health, Milano, Lombardia, Italy;
| | - Giancarlo Albo
- La Fondazione IRCCS Ospedale Maggiore Policlinico, 9339, Urology, Milano, Milano, Italy.,Università degli Studi di Milano, 9304, Department of Clinical Sciences and Community Health, Milano, Lombardia, Italy;
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13
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Liu G, Yao Z, Chen G, Li Y, Liang B. Laparoscopic compared with open nephroureterectomy in upper urinary tract urothelial carcinoma: A systemic review and a meta-analysis. Int J Clin Pract 2021; 75:e14639. [PMID: 34309982 DOI: 10.1111/ijcp.14639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We performed a meta-analysis to evaluate the effects of open nephroureterectomy compared with laparoscopic nephroureterectomy on postoperative results in upper urinary tract urothelial carcinoma subjects. METHODS A systematic literature search up to January 2021 was done and 36 studies included 23 013 subjects with upper urinary tract urothelial carcinoma at the start of the study; 8178 of them were laparoscopic nephroureterectomy, and 14 835 of them were open nephroureterectomy. They were reporting relationships between the efficacy and safety of open nephroureterectomy compared with laparoscopic nephroureterectomy in the treatment of upper urinary tract urothelial carcinoma. We calculated the odds ratio (OR) or the mean difference (MD) with 95% confidence intervals (CIs) to assess the efficacy and safety of open nephroureterectomy compared with laparoscopic nephroureterectomy in the treatment of upper urinary tract urothelial carcinoma using the dichotomous or continuous method with a random or fixed-effect model. RESULTS Laparoscopic nephroureterectomy in subjects with upper urinary tract urothelial carcinoma was significantly related to longer operation time (MD, 43.90; 95% CI, 20.91-66.90, P < .001), shorter hospital stay (MD, -1.71; 95% CI, -2.42 to -1.00, P < .001), lower blood loss (MD, -133.82; 95% CI, -220.92 to -46.73, P = .003), lower transfusion need (OR, 0.56; 95% CI, 0.47-0.67, P < .001) and lower overall complication (OR, 0.79; 95% CI, 0.70-0.90, P < .001) compared with open nephroureterectomy. However, no significant difference was found between laparoscopic nephroureterectomy and open nephroureterectomy in subjects with upper urinary tract urothelial carcinoma in 2-5-years recurrence-free survival (OR, 0.90; 95% CI, 0.69-1.18, P = .46), 2-5-years cancer-specific survival (OR, 0.94; 95% CI, 0.69-1.28, P = .68) and 2-5-years overall survival (OR, 1.31; 95% CI, 0.91-1.87, P = .15). CONCLUSIONS Laparoscopic nephroureterectomy in subjects with upper urinary tract urothelial carcinoma may have a longer operation time, shorter hospital stay, lower blood loss, transfusion need and overall complication compared with open nephroureterectomy. Further studies are required to validate these findings.
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Affiliation(s)
- Guihong Liu
- Department of Urology, Sanya Central Hospital (Hainan Third People's Hospital), Sanya, China
| | - Zeqin Yao
- Department of Urology, Sanya Central Hospital (Hainan Third People's Hospital), Sanya, China
| | - Guoqiang Chen
- Department of Urology, Sanya Central Hospital (Hainan Third People's Hospital), Sanya, China
| | - Yalang Li
- Department of Urology, Yuzhou People's Hospital, Xuchang, China
| | - Bing Liang
- Department of Urology, Sanya Central Hospital (Hainan Third People's Hospital), Sanya, China
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14
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Liu G, Yao Z, Chen G, Li Y, Liang B. Open Nephroureterectomy Compared to Laparoscopic in Upper Urinary Tract Urothelial Carcinoma: A Meta-Analysis. Front Surg 2021; 8:729686. [PMID: 34485377 PMCID: PMC8414582 DOI: 10.3389/fsurg.2021.729686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background: In this meta-analysis, we will focus on evaluating the effects of open nephroureterectomy compared with laparoscopic nephroureterectomy on postoperative results in upper urinary tract urothelial carcinoma subjects. Methods: A systematic literature search up to January 2021 was performed, and 36 studies included 23,013 subjects with upper urinary tract urothelial carcinoma at the start of the study; of them, 8,178 were laparoscopic nephroureterectomy, and 14,835 of them were open nephroureterectomy. They were reporting relationships between the efficacy and safety of open nephroureterectomy compared with laparoscopic nephroureterectomy in the treatment of upper urinary tract urothelial carcinoma. We calculated the odds ratio (OR) or the mean difference (MD) with 95% CIs to evaluate the efficacy and safety of open nephroureterectomy compared with laparoscopic nephroureterectomy in the treatment of upper urinary tract urothelial carcinoma using the dichotomous or continuous method with a random or fixed-effect model. Results: Laparoscopic nephroureterectomy in subjects with upper urinary tract urothelial carcinoma was significantly related to longer operation time (MD, 43.90; 95% CI, 20.91–66.90, p < 0.001), shorter hospital stay (MD, −1.71; 95% CI, −2.42 to −1.00, p < 0.001), lower blood loss (MD, −133.82; 95% CI, −220.92 to −46.73, p = 0.003), lower transfusion need (OR, 0.56; 95% CI, 0.47–0.67, p < 0.001), and lower overall complication (OR, 0.79; 95% CI, 0.70–0.90, p < 0.001) compared with open nephroureterectomy. However, no significant difference was found between laparoscopic nephroureterectomy and open nephroureterectomy in subjects with upper urinary tract urothelial carcinoma in 2–5 years recurrence-free survival (OR, 0.90; 95% CI, 0.69–1.18, p = 0.46), 2–5 years cancer-specific survival (OR, 0.94; 95% CI, 0.69–1.28, p = 0.68), and 2–5 years overall survival (OR, 1.31; 95% CI, 0.91–1.87, p = 0.15). Conclusion: Laparoscopic nephroureterectomy in subjects with upper urinary tract urothelial carcinoma may have a longer operation time, shorter hospital stay, and lower blood loss, transfusion need, and overall complication compared to open nephroureterectomy. Further studies are required to validate these findings.
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Affiliation(s)
- Guihong Liu
- Department of Urology, Sanya Central Hospital (Hainan Third People's Hospital), Sanya, China
| | - Zeqin Yao
- Department of Urology, Sanya Central Hospital (Hainan Third People's Hospital), Sanya, China
| | - Guoqiang Chen
- Department of Urology, Sanya Central Hospital (Hainan Third People's Hospital), Sanya, China
| | - Yalang Li
- Department of Urology, Yuzhou People's Hospital, Xuchang, China
| | - Bing Liang
- Department of Urology, Sanya Central Hospital (Hainan Third People's Hospital), Sanya, China
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15
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Chavarriaga J, Becerra LM, Camacho D, Godoy F, Varela R. Renal fossa recurrence with synchronous port site and appendicular metastases after laparoscopic nephrectomy: Role of metastases and abdominal wall en bloc resection. Urol Case Rep 2021; 38:101681. [PMID: 33996494 PMCID: PMC8099734 DOI: 10.1016/j.eucr.2021.101681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/09/2021] [Accepted: 04/11/2021] [Indexed: 11/21/2022] Open
Abstract
Isolated renal fossa recurrence and port site metastasis after laparoscopic nephrectomy are two different entities, and despite being rare, in selected cases would benefit from surgical resection. We report the case of a 61-year-old male with local renal fossa recurrence with synchronous metastasis involving the port site, the abdominal wall and the appendix, which was successfully treated with open surgical resection and is free of metastasis or recurrence. To conclude opportune treatment of similar cases, remain a safe and curative option, and should be considered after reviewing the case within a multidisciplinary team.
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Affiliation(s)
- Julián Chavarriaga
- Division of Urology, Pontificia Universidad Javeriana, Bogotá, Carrera 7 # 40-62, Colombia.,Department of Urologic Oncology, Instituto Nacional de Cancerologia, Bogotá, Colombia
| | - Luis Miguel Becerra
- Department of Urologic Oncology, Instituto Nacional de Cancerologia, Bogotá, Colombia
| | - Diego Camacho
- Department of Urologic Oncology, Instituto Nacional de Cancerologia, Bogotá, Colombia
| | - Fabián Godoy
- Department of Urologic Oncology, Instituto Nacional de Cancerologia, Bogotá, Colombia
| | - Rodolfo Varela
- Department of Urologic Oncology, Instituto Nacional de Cancerologia, Bogotá, Colombia
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16
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Port-site metastasis and atypical recurrences after robotic-assisted radical cystectomy (RARC): an updated comprehensive and systematic review of current evidences. J Robot Surg 2020; 14:805-812. [PMID: 32152900 DOI: 10.1007/s11701-020-01062-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
The objective of this systematic review is to evaluate the current evidence regarding atypical metastases in patients undergoing robotic-assisted radical cystectomy (RARC). A review of the current literature was conducted through the Medline and NCBI PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases in October 2019. From the literature search using the cited keys and after a careful evaluation of the full texts, we included 31 articles in the study. Fourteen studies (45.2%) reported at least an atypical recurrence during the follow-up period with a rate between 4 and 40% of all the recurrences. Overall, 105 (1.63%) of the 6720 patients who have been evaluated in the included studies developed an atypical recurrence. Sixty-three (60%) of these atypical metastases were peritoneal carcinomatosis, 16 (15.2%) extrapelvic lymph nodes metastases, 11 (10.5%) port-site metastases, 10 (9.5%) retroperitoneal nodal metastases, while 5 (3.8%) patients developed more than one type of atypical recurrence. In literature, there is a low but not negligible incidence of atypical recurrences after RARC. However, publication bias and retrospective design of most studies could influence the evidences. Further prospective randomized studies are needed to clarify the real risk of patients undergoing RARC to develop atypical metastases.
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17
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Anil H, İslamoğlu E, Özsoy Ç, Ateş M, Savaş M. Atypical Early Recurrence after Robot-Assisted Radical Cystectomy: Port-Site Metastasis. Curr Urol 2020; 13:214-216. [PMID: 31998054 DOI: 10.1159/000499269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/17/2018] [Indexed: 01/28/2023] Open
Abstract
Port-site metastasis (PSM) have gained importance due to increasing number of robot-assisted radical cystectomy (RARC). To the best of our knowledge, there are 13 cases in the literature, with only one reporting, treatment modality and oncological outcome. There is no consensus about the treatment for PSM developing after RARC. Here, we report a PSM occurring in the early period after RARCand recommend a treatment modality.
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Affiliation(s)
- Hakan Anil
- University of Health Sciences, Urology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ekrem İslamoğlu
- University of Health Sciences, Urology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Çağatay Özsoy
- University of Health Sciences, Urology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mutlu Ateş
- University of Health Sciences, Urology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Murat Savaş
- University of Health Sciences, Urology, Antalya Training and Research Hospital, Antalya, Turkey
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18
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Fujimura T. Current status and future perspective of robot-assisted radical cystectomy for invasive bladder cancer. Int J Urol 2019; 26:1033-1042. [PMID: 31364203 DOI: 10.1111/iju.14076] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/30/2019] [Indexed: 12/21/2022]
Abstract
The current status of robot-assisted radical cystectomy was reviewed 16 years after the initial robot-assisted radical cystectomy for the treatment of invasive bladder cancer. Articles associated with robot-assisted radical cystectomy and written in English were selected from the PubMed database from January 2003 to February 2019. The present review article focused on the distribution of robot-assisted radical cystectomy, patient selection, preoperative management, surgical technique, lymph node dissection, urinary diversion, recurrence pattern, oncological outcomes, cost, learning curve, complications and educational programs. A total of 400 articles were divided according to the country of the first author's affiliation. The USA was the most dominant at 198 (50%), whereas the number of articles from the countries belonging to the Urological Association of Asia was 15 (3.8%) for China, 17 (4.3%) for South Korea, 10 (2.5%) for Japan, eight (2%) for Taiwan, eight (2%) for Turkey and one (0.2%) for Iran. The percentage of robot-assisted radical cystectomy carried out is increasing, and intracorporeal urinary diversion and ileal neobladder are also frequently carried out. With a refined technique being performed in high-volume centers, robot-assisted radical cystectomy has contributed to the reduction in transfusion rate, length of stay and severe complications; however, it has not yet shown any cancer-specific survival benefits. Robot-assisted radical cystectomy is not fully spread throughout the Urological Association of Asia. Further investigation with respect to worldwide results is needed to prove the real benefit of robot-assisted radical cystectomy regarding low morbidity, reduced total medical cost, and survival benefit. In the era of precision medicine, appropriate drug and surgery will be given based on each genetic profile.
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Affiliation(s)
- Tetsuya Fujimura
- Department of Urology, Jichi Medical University, Shimotsuke, Tochigi, Japan
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19
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Kang Q, Yu Y, Yang B. Incidence of Port Site Metastasis in Laparoscopic Radical Nephroureterectomy: Single-institution Experience. Urology 2019; 131:130-135. [PMID: 31202854 DOI: 10.1016/j.urology.2019.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/25/2019] [Accepted: 06/03/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To address the incidence and potential risk factors of port site metastasis (PSM) in patients who underwent laparoscopic radical nephroureterectomy (RNU) for upper tract urothelial carcinoma. MATERIALS AND METHODS Between January 2013 and December 2018 laparoscopic RNU were performed in 240 patients at our institution, including 145 with renal pelvic tumor and 135 with ureteral tumor (40 patients have both tumor). Laparoscopies were performed through the transperitoneal approach in 28 patients, and retroperitoneal in 212 patients. Clinical data are retrospectively collected. RESULTS Perioperative and pathologic data are available in all 240 cases. After a mean follow-up of 12.6 months (range 3-45 months), 4 patients (1.7%) developed PSM following retroperitoneal RNU at an average of 4.3 months. Tumor stage is T2N0M0 in one, T3N0M0 in two, and T3N1M0 in one, respectively. Tumor grade are high-grade urothelial carcinoma in all. The incidence of PSM is 2.8% (4/145) and 0.7% (1/135) in renal pelvic and ureteral tumor, respectively. CONCLUSION We report a 1.7% incidence of PSM in upper tract urothelial carcinoma after laparoscopic RNU. We suggest that air leakage during retroperitoneal approach, high tumor stage (pT3) and grade, and advanced renal pelvic tumor with micrometastases could increase the potential risks of PSM.
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Affiliation(s)
- Qianyu Kang
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yang Yu
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Bo Yang
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, Liaoning, China.
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20
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Baldissera Aradas JV, Rodríguez Villamil L, Fernández-Pello Montes S, Gil Ugarteburu R, Mosquera Madera J. Laparoscopic nephroureterectomy with laser endoscopic transuretral disinsertion in lateral decubitus: progressive adaptation to retroperitoneocopic approach. Actas Urol Esp 2018; 42:649-658. [PMID: 29576194 DOI: 10.1016/j.acuro.2018.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND The ureteral disinsertion with bladder cuff technique continues to evolve. We present the endoscopic laser transurethral technique combined with a transperitoneal and retroperitoneal laparoscopic approach in lateral decubitus, without patient repositioning, for treating urothelial carcinomas of the upper urinary tract. MATERIALS AND METHODS We present 3 laparoscopic nephroureterectomies: 1 transperitoneal and 2 retroperitoneal. Disinsertion was performed in lateral decubitus using a flexible cystoscope and a 365-μm holmium laser fiber. The endoscopic technique was progressively adapted to 3-port and single-port retroperitoneoscopic approaches. Before laparoscopic handling of the kidney, ureter was clamped below the tumour. The endoscopic technique was then started. Both approaches were simultaneously employed. RESULTS Nephroureterectomies were achieved performing en bloc endoscopic disinsertion of the bladder cuff and ensuring a closed system comparable to open technique. The second case required reconversion due to technical problems and extension of the surgical time. No relapses were diagnosed during follow-up. CONCLUSION Results are comparable to open surgery, technique ensured compliance to oncology principles, enabled disinsertion in lateral decubitus and avoid patient repositioning saving surgical time. The results reflect the benefits of minimally invasive surgery in all cases.
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Affiliation(s)
| | - L Rodríguez Villamil
- Servicio de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, España
| | | | - R Gil Ugarteburu
- Servicio de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, España
| | - J Mosquera Madera
- Servicio de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, España
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21
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Huguet J, Rosales A, Breda A, Palou J. Atypical relapses in laparoscopic and robot-assisted surgery of urothelial carcinoma of the urinary tract and bladder. Actas Urol Esp 2018; 42:485-487. [PMID: 29903613 DOI: 10.1016/j.acuro.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 11/16/2022]
Affiliation(s)
- J Huguet
- Unidad de Urología Oncológica, Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España.
| | - A Rosales
- Unidad de Urología Oncológica, Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
| | - A Breda
- Unidad de Urología Oncológica, Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
| | - J Palou
- Unidad de Urología Oncológica, Departamento de Urología, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, España
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22
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Liu F, Guo W, Zhou X, Ding Y, Ma Y, Hou Y, Kong X, Wang Z. Laparoscopic versus open nephroureterectomy for upper urinary tract urothelial carcinoma: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e11954. [PMID: 30170392 PMCID: PMC6393120 DOI: 10.1097/md.0000000000011954] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of laparoscopic nephroureterectomy (LNU) and open nephroureterectomy (ONU) for the treatment of upper urinary tract urothelial carcinoma (UTUC). METHODS PubMed, Embase, and Cochrane databases were selected for systematic review of trials that compared outcomes of LNU and ONU. Meta-analysis was performed using RevMan 5.3 and STATA 13.0 software. RESULTS LNU was associated with longer operation time (P < .001), shorter hospital stay (P < .001), less blood loss (P = .006) and lower rate of transfusion (P < .001). The occurrence of complications, including minor (P = .52), major (P = .21) and total complications (P = .19) were similar between LNU and ONU. There was no significant difference in the rate of 5-year recurrence-free survival (P = .90), 5-year cancer-specific survival (P = .12), and 5-year overall survival (P = .11) as well as 2-year RFS (P = .84), 2-year CSS (P = .86), and 2-year OS (P = .25). CONCLUSION Our results indicated that LNU is a safe and effective method to treat UTUC. Given the limitations of this study, further multicenter, randomized trials are required to confirm these findings.
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Affiliation(s)
| | | | | | - Youpeng Ding
- Department of Urology, China–Japan Union Hospital of Jilin University, Changchun, PR China
| | - Yanan Ma
- Department of Urology, China–Japan Union Hospital of Jilin University, Changchun, PR China
| | - Yi Hou
- Department of Urology, China–Japan Union Hospital of Jilin University, Changchun, PR China
| | - Xiangbo Kong
- Department of Urology, China–Japan Union Hospital of Jilin University, Changchun, PR China
| | - Zhixin Wang
- Department of Urology, China–Japan Union Hospital of Jilin University, Changchun, PR China
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Teo K, Wynne C, Bax K, Roadley G. Isolated port-site prostate metastasis after robot-assisted laparoscopic radical prostatectomy. ANZ J Surg 2018; 89:E443-E444. [PMID: 30047183 DOI: 10.1111/ans.14730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 05/02/2018] [Accepted: 05/09/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Keith Teo
- Department of General Surgery, Timaru Public Hospital, Timaru, New Zealand
| | - Chris Wynne
- Department of Oncology, St George's Hospital, Christchurch, New Zealand
| | - Kevin Bax
- Department of Urology, Forte Hospital, Christchurch, New Zealand
| | - Graeme Roadley
- Department of General Surgery, Timaru Public Hospital, Timaru, New Zealand
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Klotz T, Schneider S. [Subcutaneous port site metastasis after da Vinci radical laparoscopic prostatectomy]. Urologe A 2018; 57:191-192. [PMID: 29374289 DOI: 10.1007/s00120-018-0573-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T Klotz
- Klinik für Urologie, Andrologie und Kinderurologie, Kliniken Nordoberpfalz AG, Söllnerstr. 16, 92637, Weiden, Deutschland.
| | - S Schneider
- Urologiezentrum Schwandorf, Schwandorf, Deutschland
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Audenet F, Sfakianos JP. Evidence of Atypical Recurrences After Robot-Assisted Radical Cystectomy: A Comprehensive Review of the Literature. Bladder Cancer 2017; 3:231-236. [PMID: 29152547 PMCID: PMC5676761 DOI: 10.3233/blc-170127] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Robot-assisted radical cystectomy (RARC) has seen remarkable growth in the last decade. Despite a low level of evidence, numerous publications reporting on outcomes after RARC are now available. While definitive data on the long-term oncologic safety and efficacy of this technique are still lacking, similar oncological and functional outcomes compared to open radical cystectomy (ORC) have been reported. Several studies have also reported on atypical recurrences after RARC, including peritoneal carcinomatosis, extra-pelvic lymph node metastasis and port-site metastasis. While distant metastases overall do not appear to be affected by technique, it is possible that RARC may be associated with an increased risk of some atypical recurrences and this should be prospectively studied in RARC. However, atypical recurrences are rare events and are infrequent in their description. To date, there is no convincing evidence that, in the hands of equally experienced surgeons who treat bladder cancer routinely, a skillfully performed RARC is less oncologically efficacious than a skillfully performed ORC.
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Affiliation(s)
- François Audenet
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
Background Techniques in genitourinary oncologic surgery have evolved over the past several years, shifting from traditional open approaches toward minimally invasive routes by laparoscopy. Methods We reviewed the literature on laparoscopic surgery for genitourinary cancer, with emphasis on contemporary indications, complications, and oncologic outcome of laparoscopic surgery for urologic malignancies. Results All urologic oncology procedures have been performed laparoscopically. Laparoscopic radical nephrectomy is becoming the preferred approach for managing kidney cancer. The initial experience with nephroureterectomy is encouraging. Laparoscopic radical prostatectomy is rapidly becoming the standard in Europe and is the procedure of choice in many centers in the United States. Conclusions When following the open oncologic principles for the surgical treatment of malignancies, laparoscopy offers similar oncologic clinical outcomes, less morbidity, improved operative precision, and reduced convalescence time.
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Affiliation(s)
- Alejandro Rodriguez
- Genitourinary Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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Shimokihara K, Kawahara T, Takamoto D, Mochizuki T, Hattori Y, Teranishi JI, Miyoshi Y, Chiba S, Uemura H. Port site recurrence after laparoscopic radical nephrectomy: a case report. J Med Case Rep 2017; 11:151. [PMID: 28592262 PMCID: PMC5463387 DOI: 10.1186/s13256-017-1319-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/01/2017] [Indexed: 11/24/2022] Open
Abstract
Background Due to the recent development of laparoscopic devices, laparoscopic radical nephrectomy is the standard procedure for localized renal cell carcinoma. However, some studies have reported postoperative port site metastasis in several cancers. Case presentation A 68-year-old Asian-Japanese man was referred to our hospital for a further examination of his right renal tumor in 2009. Due to a clinical suspicion of renal cell carcinoma, laparoscopic nephrectomy was performed. The histopathological diagnosis was clear cell renal cell carcinoma. Follow-up computed tomography revealed a mass between the internal oblique muscle of his abdomen and the transverse muscle of his abdomen in 2014. The tumor size gradually increased, and positron emission tomography-computed tomography revealed the accumulation of fludeoxyglucose in that tumor with maximum standardized uptake value of 2.7. Based on these findings, port site recurrence was suspected, and tumor resection was performed in 2017. The pathological diagnosis was metastatic clear cell renal cell carcinoma. Conclusions Here we report a rare case of port site metastasis that was successfully treated 7 years after laparoscopic nephrectomy.
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Affiliation(s)
- Kota Shimokihara
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Kawahara
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan.
| | - Daiji Takamoto
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Taku Mochizuki
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Yusuke Hattori
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Jun-Ichi Teranishi
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasuhide Miyoshi
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Sawako Chiba
- Department of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroji Uemura
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
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Port Site Recurrence Following a Robotic Laparoscopic Radical Nephroureterectomy for Sarcomatoid Variant of Urothelial Carcinoma. Urol Case Rep 2017; 13:82-84. [PMID: 28480168 PMCID: PMC5412008 DOI: 10.1016/j.eucr.2016.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 10/20/2016] [Indexed: 11/24/2022] Open
Abstract
Port Site Recurrence (PSR) following laparoscopic tumor resections has been reported for a variety of tumors. Though PSR is a rare phenomenon, they most commonly occur following nephroureterectomies for upper tract urothelial carcinoma. Herein we report a novel case of a PSR following a robotic assisted nephroureterectomy for the sarcomatoid variant of urothelial carcinoma of the upper urinary tract.
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Yoshino H, Miyamoto K, Hwang EC, Yamane T, Nakagawa M, Enokida H. Is It Safe to Use the Same Scissors After Accidental Tumor Incision During Partial Nephrectomy? Results of In Vitro and In Vivo Experiments. J Endourol 2017; 31:391-395. [PMID: 28049342 DOI: 10.1089/end.2016.0848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE When accidental tumor incision (ATI) has occurred during open partial nephrectomy (PN), scissors can be changed easily. In contrast, during laparoscopic partial nephrectomy (LPN) or robotic partial nephrectomy (RPN), it is time consuming and expensive especially during RPN to change scissors. This study investigates whether tumor cells remain on the surface of scissors after ATI during PN and investigates an alternative way to avoid changing scissors during LPN and RPN. MATERIALS AND METHODS We subcutaneously injected 786-O renal-cell carcinoma (RCC) cells containing enhanced green fluorescent protein (786-O/EGFP) into six mice. We incised the subsequent tumor with straight or Microline scissors. The scissor surfaces were then examined by microscopy for detection of EGFP immunofluorescence. In addition, the scissor surfaces were treated in three ways: no electrical treatment, electrical treatment of 20 W for 5 seconds, and electrical treatment of 40 W for 5 seconds. RESULTS Strings or dots of EGFP were detected on every scissor surface, and 786-O/EGFP cells were alive and able to proliferate in medium in 33% of the nonelectrically treated samples. However, no 786-O/EGFP cells treated with monopolar electricity survived. In another experiment, we also found that 100 786-O cells placed on scissor surfaces could not survive after the same electrical treatment. CONCLUSIONS RCC cells remained on scissors after ATI; however, electrical treatment eliminated tumor cells, possibly preventing recurrence or metastasis after surgery.
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Affiliation(s)
- Hirofumi Yoshino
- 1 Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima, Japan
| | - Kazutaka Miyamoto
- 1 Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima, Japan
| | - Eu-Chang Hwang
- 2 Department of Urology, Chonnam National University Medical School , Gwangju, Korea
| | - Takashi Yamane
- 1 Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima, Japan
| | - Masayuki Nakagawa
- 1 Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima, Japan
| | - Hideki Enokida
- 1 Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima, Japan
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Re: Critical Analysis of Early Recurrence after Laparoscopic Radical Cystectomy in a Large Cohort by the ESUT: S. Albisinni, L. Fossion, M. Oderda, O. M. Aboumarzouk, F. Aoun, T. Tokas, V. Varca, R. Sanchez-Salas, X. Cathelineau, P. Chlosta, F. Gaboardi, U. Nagele, T. Piechaud, J. Rassweiler, P. Rimington, L. Salomon and R. van Velthoven J Urol 2016;195:1710-1717. J Urol 2016; 196:1319-21. [PMID: 27393901 DOI: 10.1016/j.juro.2016.05.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2016] [Indexed: 12/30/2022]
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Wang N, Wang K, Zhong D, Liu X, Sun JI, Lin L, Ge L, Yang BO. Port-site metastasis as a primary complication following retroperitoneal laparoscopic radical resection of renal pelvis carcinoma or nephron-sparing surgery: A report of three cases and review of the literature. Oncol Lett 2016; 11:3933-3938. [PMID: 27313720 PMCID: PMC4888130 DOI: 10.3892/ol.2016.4541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 03/01/2016] [Indexed: 12/22/2022] Open
Abstract
The present study reports the clinical data of two patients with renal pelvis carcinoma and one patient with renal carcinoma who developed port-site metastasis following retroperitoneal laparoscopic surgery. The current study aimed to identify the cause and prognosis of the occurrence of port-site metastasis subsequent to laparoscopic radical resection of renal pelvis carcinoma and nephron-sparing surgery. Post-operative pathology confirmed the presence of high-grade urothelial cell carcinoma in two patients and Fuhrman grade 3 renal clear cell carcinoma in one patient. Port-site metastasis was initially detected 1–7 months post-surgery. The two patients with renal pelvis carcinoma succumbed to the disease 2 and 4 months following the identification of the port-site metastasis, respectively, whereas the patient with renal carcinoma survived with no disease progression during the targeted therapy period. The occurrence of port-site metastasis may be attributed to systemic and local factors. Measures to reduce the development of this complication include strict compliance with the operating guidelines for tumor surgery, avoidance of air leakage at the port-site, complete removal of the specimen with an impermeable bag, irrigation of the laparoscopic instruments and incisional wound with povidone-iodine when necessary, and enhancement of the body's immunity. Close post-operative follow-up observation for signs of recurrence or metastasis is essential, and systemic chemotherapy may be required in patients with high-grade renal pelvis carcinoma and renal carcinoma in order to prolong life expectancy.
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Affiliation(s)
- Ning Wang
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China; Hangzhou Tourism Vocational School, Hangzhou, Zhejiang 311200, P.R. China
| | - Kai Wang
- Department of Urology, Zhejiang Xiaoshan Hospital, Hangzhou, Zhejiang 311202, P.R. China
| | - Dachuan Zhong
- Department of Urology, Zhejiang Xiaoshan Hospital, Hangzhou, Zhejiang 311202, P.R. China
| | - Xia Liu
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| | - J I Sun
- Department of Urology, Zhejiang Xiaoshan Hospital, Hangzhou, Zhejiang 311202, P.R. China
| | - Lianxiang Lin
- Department of Urology, Zhejiang Xiaoshan Hospital, Hangzhou, Zhejiang 311202, P.R. China
| | - Linna Ge
- Department of Radiology, The General Hospital of Jixi Mining Group, Jixi, Heilongjiang 158100, P.R. China
| | - B O Yang
- Department of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
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Huang SY, Ahrar K, Gupta S, Wallace MJ, Ensor JE, Krishnamurthy S, Matin SF. Safety and diagnostic accuracy of percutaneous biopsy in upper tract urothelial carcinoma. BJU Int 2014; 115:625-32. [DOI: 10.1111/bju.12824] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Steven Y. Huang
- Department of Interventional Radiology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Kamran Ahrar
- Department of Interventional Radiology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Sanjay Gupta
- Department of Interventional Radiology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Michael J. Wallace
- Department of Interventional Radiology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Joe E. Ensor
- Department of Biostatistics; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Savitri Krishnamurthy
- Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Surena F. Matin
- Department of Urology; The University of Texas MD Anderson Cancer Center; Houston TX USA
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Acar O, Esen T, Bavbek S, Peker O, Musaoğlu A. Port site and peritoneal metastases after robot-assisted radical prostatectomy. Int J Surg Case Rep 2014; 5:131-4. [PMID: 24531016 DOI: 10.1016/j.ijscr.2014.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/17/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Port site metastasis after minimally invasive urologic surgery is a rare event despite the widespread utility of laparoscopic techniques in the management of urologic malignancies. Herein, we report a case of port site metastasis after robot-assisted radical prostatectomy. PRESENTATION OF CASE A currently 77-year-old male patient, who was diagnosed with cT2c, Gleason 7 (4+3) prostate adenocarcinoma in our clinic back in 2009, had undergone robot-assisted radical prostatectomy elsewhere. Histopathological examination revealed pT3a, Gleason 9 (4+5) disease. Lymph nodes were negative, however surgical margins were positive on the right side. PSA recurred after 9 months and maximal androgen blockade was initiated. Despite antiandrogenic manipulations, PSA reached 0.83ng/ml, 33 months postoperatively. Concurrently, we noticed a palpable anterior abdominal mass which demonstrated metabolic hyperactivity on PET scanning. Percutaneous biopsy of the lesion confirmed the presence of metastatic adenocarcinoma. PSA did not normalize after the complete excision of the metastatic focus. Repeated PET scan revealed multiple implants on the peritoneal surfaces of various organs. DISCUSSION Port site and peritoneal metastasis of prostate cancer after robot-assisted radical prostatectomy has not been reported so far. This peculiar dissemination pattern is most probably the result of tumor biology and perioperative factors. CONCLUSION Although encountered extremely rarely, surgeons should be aware of the possibility of port site and/or peritoneal metastases after minimally invasive radical prostatectomy.
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Affiliation(s)
- Omer Acar
- Department of Urology, VKF American Hospital, Nisantasi, 34365 Istanbul, Turkey.
| | - Tarık Esen
- Department of Urology, VKF American Hospital, Nisantasi, 34365 Istanbul, Turkey; School of Medicine, Koc University, Rumelifeneri Yolu, 34450 Istanbul, Turkey
| | - Sevil Bavbek
- Department of Medical Oncology, VKF American Hospital, Nisantasi, 34365 Istanbul, Turkey
| | - Onder Peker
- Department of Pathology, VKF American Hospital, Nisantasi, 34365 Istanbul, Turkey
| | - Ahmet Musaoğlu
- Department of Urology, VKF American Hospital, Nisantasi, 34365 Istanbul, Turkey
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Rizk R, Danse E, Aydin S, Tombal B, Machiels JP. Castrate-resistant prostate cancer with peritoneal metastases treated with docetaxel-based chemotherapy. Urol Int 2013; 93:49-54. [PMID: 24296400 DOI: 10.1159/000354396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 07/15/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To identify the risk factors, characteristics and prognosis of patients treated with docetaxel-based chemotherapy for peritoneal carcinomatosis due to metastatic castrate-resistant prostate cancer (mCRPC). METHODS We retrospectively reviewed our series of mCRPC patients with peritoneal metastases treated with docetaxel-based chemotherapy between 2004 and 2010. RESULTS Six patients were identified from our institutions' internal cancer registry. Three out of these patients had been treated with laparoscopic radical prostatectomy (LRP). In addition to peritoneal metastases, other metastatic sites were mainly visceral. Only 1 patient developed bone metastases. Peritoneal carcinomatosis occurred mainly in patients with a high Gleason (= or >6) score since 5 out of our 6 patients had a Gleason score ≥7. All 6 patients were treated with docetaxel-based chemotherapy when they developed castration resistance. Five patients benefitted from chemotherapy according to their PSA or RECIST responses. Median survival from the start of docetaxel was 24.5 months. CONCLUSIONS Our retrospective analysis suggests that peritoneal carcinomatosis occurs mainly in patients with a high Gleason score. It is also possible that tumor seeding occurs during LRP. Patients with peritoneal carcinomatosis resistant to castration seem to benefit from docetaxel-based chemotherapy.
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Affiliation(s)
- Rita Rizk
- Department of Medical Oncology, Cancer Center, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Ito K, Takagi T, Kondo T, Yoshida K, Iizuka J, Kobayashi H, Tomita E, Hashimoto Y, Tanabe K. Cystic local recurrence of renal cell carcinoma after laparoscopic radical nephrectomy in a hemodialysis patient. Int J Urol 2013; 21:330-2. [PMID: 23909823 DOI: 10.1111/iju.12239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 06/28/2013] [Indexed: 10/26/2022]
Abstract
Although local recurrence of renal cell carcinoma after laparoscopic radical nephrectomy is sometimes reported, cystic local recurrence of renal cell carcinoma has rarely been reported. We report the case of a 59-year-old man with hemodialysis who developed cystic local recurrence of renal cell carcinoma accompanied by acquired cystic disease of the kidney in the retroperitoneal space after laparoscopic radical nephrectomy. A cystic tumor of 5.1 cm in diameter occurred in the left retroperitoneal space 15 months after left laparoscopic radical nephrectomy, and enlarged to 7.2 cm in diameter with enhanced mass along the wall of the cyst 36 months after surgery. The cystic tumor was removed and showed local recurrence of renal cell carcinoma on pathological examination.
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Affiliation(s)
- Kazuyo Ito
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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Tumor seeding incidentally found two years after robotic-Assisted radical nephrectomy for papillary renal cell carcinoma. A case report and review of the literature. Int J Surg Case Rep 2013; 4:561-4. [PMID: 23632074 DOI: 10.1016/j.ijscr.2013.03.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 03/14/2013] [Accepted: 03/14/2013] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Port-site metastasis or peritoneal spread after laparoscopic surgery for urological malignancies is a rare phenomenon accounting for 0.09% and 0.03% of the cases respectively. PRESENTATION OF CASE We present a case of tumor seeding in the omentum found in a female patient after previous transperitoneal robotic-assisted radical nephrectomy (RARN) for papillary renal cell carcinoma (RCC). Two years after the robotic operation, the patient was diagnosed with cervical clear cell carcinoma and underwent radical hysterectomy with lymphadenectomy and omentectomy. A neoplastic omental nodule was incidentally identified intraoperatively. Pathological characteristics and immunohistochemistry revealed features of papillary RCC. Two years after the hysterectomy, the patient is clinically cancer free, without any adjuvant therapy for her cervical cancer. DISCUSSION To the best of our knowledge, we report the first case of tumor seeding in the omentum following RARN for organ confined low grade papillary (T2aN0M0) RCC. No risk factors that could explain the tumor seeding were identified. The neoplastic cells had a low proliferative index (Ki-67<5%) and a decreased capability to metastasize. CONCLUSION Tumor seeding as a result of robotic assisted laparoscopic nephrectomy, although rare, might represent a novel way of tumor inoculation deprived of or with low malignant potential.
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Song JB, Tanagho YS, Kim EH, Abbosh PH, Vemana G, Figenshau RS. Camera-port site metastasis of a renal-cell carcinoma after robot-assisted partial nephrectomy. J Endourol 2013; 27:732-9. [PMID: 23297710 DOI: 10.1089/end.2012.0533] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Port-site metastasis (PSM) is a rare complication of laparoscopic intervention in urologic malignancies. Of the greater than 50 reported cases of PSM in the urologic oncology literature, only 9 have occurred after surgery for renal-cell carcinoma (RCC). We report a 10th instance of RCC metastasis-in this case to the camera-port site after robot-assisted partial nephrectomy (RAPN). To our knowledge, this case is the first reported PSM of RCC after RAPN. PATIENT AND METHODS A 68-year-old man underwent an uncomplicated right RAPN for a 4-cm right renal mass (stage T1aN0M0). Five months later, he was found to have metastatic disease with an isolated peritoneal recurrence at the camera-port site. Biopsy of the lesion confirmed RCC, and the lesion was surgically resected. A comprehensive MEDLINE search for all published studies of port-site recurrences after laparoscopic renal surgery for RCC was performed. RESULTS Nine cases of PSM after successful laparoscopic radical or partial nephrectomy for locally confined RCC have been reported. Proposed etiologic factors for port-site recurrence include biologic aggressiveness of the tumor, patient immunosuppression, local wound factors, and technique-related factors. We report an unusual case of PSM to a camera port that was not used for specimen manipulation or extraction. CONCLUSION PSM after laparoscopic renal surgery for RCC is a rare occurrence. Our case, in which PSM occurred without specimen bag rupture or extraction through the port in question, highlights the importance of local and systemic factors in contributing to PSM occurrence. We also demonstrate that when PSM is the only site of disease recurrence, it can be successfully managed with minimally invasive surgical resection.
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Affiliation(s)
- Joseph B Song
- Division of Urology, Washington University School of Medicine, St. Louis, MO 63110, USA
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Oncological Outcomes of Laparoscopic and Open Treatment (Nephroureterectomy) for Urothelial Tumors of the Upper Urinary Tract. Urologia 2012; 79 Suppl 19:82-5. [DOI: 10.5301/ru.2012.9721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2012] [Indexed: 11/20/2022]
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Sugihara T, Yasunaga H, Horiguchi H, Fujimura T, Nishimatsu H, Tsuru N, Kazuo S, Ohe K, Fushimi K, Homma Y. Regional, institutional and individual factors affecting selection of minimally invasive nephroureterectomy in Japan: A national database analysis. Int J Urol 2012. [DOI: 10.1111/iju.12031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Hideo Yasunaga
- Department of Health Management and Policy; The University of Tokyo; Tokyo; Japan
| | - Hiromasa Horiguchi
- Department of Health Management and Policy; The University of Tokyo; Tokyo; Japan
| | - Tetsuya Fujimura
- Department of Urology; Faculty of Medicine; The University of Tokyo; Tokyo; Japan
| | - Hiroaki Nishimatsu
- Department of Urology; Faculty of Medicine; The University of Tokyo; Tokyo; Japan
| | - Nobuo Tsuru
- Department of Urology; Shintoshi Hospital; Iwata; Japan
| | - Suzuki Kazuo
- Department of Urology; Shintoshi Hospital; Iwata; Japan
| | - Kazuhiko Ohe
- Department of Medical Informatics and Economics; Graduate School of Medicine; The University of Tokyo; Tokyo; Japan
| | - Kiyohide Fushimi
- Department of Health Care Informatics; Tokyo Medical and Dental University; Tokyo; Japan
| | - Yukio Homma
- Department of Urology; Faculty of Medicine; The University of Tokyo; Tokyo; Japan
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Liu QD, Chen JZ, Xu XY, Zhang T, Zhou NX. Incidence of port-site metastasis after undergoing robotic surgery for biliary malignancies. World J Gastroenterol 2012; 18:5695-701. [PMID: 23155309 PMCID: PMC3484337 DOI: 10.3748/wjg.v18.i40.5695] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 07/31/2012] [Accepted: 08/04/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the incidence of clinically detected port-site metastasis (PSM) in patients who underwent robotic surgery for biliary malignancies.
METHODS: Using a prospective database, the patients undergoing fully robotic surgery for biliary malignancies between January 2009 and January 2011 were included. Records of patients with confirmed malignancy were reviewed for clinicopathological data and information about PSM.
RESULTS: Sixty-four patients with biliary tract cancers underwent robotic surgery, and sixty patients met the inclusion criteria. The median age was 67 year (range: 40-85 year). During a median 15-mo follow-up period, two female patients were detected solitary PSM after robotic surgery. The incidence of PSM was 3.3%. Patient 1 underwent robotic anatomatic left hemihepatectomy and extraction of biliary tumor thrombi for an Klatskin tumor. She had a subcutaneous mass located at the right lateral abdominal wall near a trocar scar. Patient 2 underwent robotic pancreaticoduodenectomy for distal biliary cancer. She had two metachronous subcutaneous mass situated at the right lateral abdominal wall under a same trocar scar at 7 and 26 mo. The pathology of the excised PSM masses confirmed metastatic biliary adenocarcinoma.
CONCLUSION: The incidence of PSMs after robotic surgery for biliary malignancies is relatively low, and biliary cancer can be an indication of robotic surgery.
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Oncologic outcomes obtained after laparoscopic, robotic and/or single port nephroureterectomy for upper urinary tract tumours. World J Urol 2012; 31:93-107. [PMID: 23097034 DOI: 10.1007/s00345-012-0968-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 09/28/2012] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Open surgery (ONU) is still considered to be the gold standard approach for nephroureterectomy (NU); however, with the introduction of laparoscopic surgery, minimally invasive techniques have been applied to surgical therapy of upper urinary tract tumours (UUT-UC) and they are gaining adepts. However, several concerns still exist about the safety of laparoscopic nephroureterectomy (LNU) in the treatment of UUT-UC, and different authors suggest that, although it could be equivalent to open surgery, this equivalence is not accomplished in all UUT-UC, suggesting that more advanced disease should undergo open surgery. More controversial still is the application of robotic surgery (RALNU) or really novel minimally invasive techniques, such as laparoendoscopic single-site surgery (LESSNU), for the treatment of UUT-UC. Although all these techniques seem feasible, their influence on oncologic results is still a matter of concern. METHODOLOGY We present a review on the oncologic outcomes of minimally invasive laparoscopic techniques in the treatment of UUT-UC. We focus our analysis on oncologic outcomes and we also analyze the different techniques proposed for the treatment of the distal ureter during minimally invasive surgery for UUT-UC. In the absence of prospective randomized studies with large patient samples, we must base our conclusions on retrospective studies and longer follow-up. CONCLUSION Given the evidence accumulated so far, LNU has proven to be equivalent or non-inferior, in terms of recurrence-free survival (RFS) and cancer-specific survival (CSS) to ONU. Nevertheless, comparative studies are needed with longer follow-up before determining the equivalence of LNU in advanced tumours.
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Chaturvedi S, Bansal V, Kapoor R, Mandhani A. Is port site metastasis a result of systemic involvement? Indian J Urol 2012; 28:169-73. [PMID: 22919132 PMCID: PMC3424893 DOI: 10.4103/0970-1591.98458] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aims: Port site metastasis (PSM) is an unwelcome consequence of laparoscopy for oncological procedures with uncertain etiology. We present the clinical evidence to prove that PSM is likely to be due to the hematogenous spread of tumor cells. Materials and Methods: Six cases of port site metastasis, four following laparoscopic radical nephrectomy for localized renal cell carcinoma (RCC), one after laparoscopic radical prostatectomy done in two patients and one after laparoscopic partial cystectomy for tumor at bladder dome done in two were studied. One case of metastatic RCC with bilateral gluteal masses and two cases of open radical nephrectomy, with recurrence at the drain and incision site were also studied. Results: During the median follow up of 59 months (range 24–120), 4/136 patients with RCC (1.47%) developed port site metastasis between 7–36 months after surgery. All six cases of PSM had advanced disease and recurrences at other sites, that is, peritoneum, omentum, bones, and lungs. None of the patients had isolated PSM. One patient of metastatic RCC, who did not have any intervention but repeated intramuscular injections of analgesics-developed bilateral gluteal masses, confirmed to be RCC on fine needle aspiration cytology. Two patients had metastasis at the incision site (one at the drain site) with distance, including cutaneous metastases. Conclusions: Port site metastasis did not develop in isolation. There could be a likely existence of circulating tumor cells at the time of surgical trauma of penetrating nature, that is, port site or injection site, which manifest in some patients depending upon their immune response.
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Affiliation(s)
- Samit Chaturvedi
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Port-site metastasis after laparoscopic surgery for urological malignancy: forgotten or missed. Adv Urol 2012; 2012:609531. [PMID: 22611383 PMCID: PMC3349242 DOI: 10.1155/2012/609531] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Revised: 10/10/2011] [Accepted: 01/16/2012] [Indexed: 11/18/2022] Open
Abstract
Purpose. Port-site metastasis has been a concern with the common use of laparoscopy in urologic oncology. We conducted this study to provide a review of port-site metastases reported after the laparoscopy in managing urologic malignancies, possible contributing factors and preventative measures. Materials and Methods. An electronic search of MEDLINE using the combined MESH key words “port-site metastasis” and “Urology”. Results. 51 articles addressing port-site metastasis after laparoscopic surgery for urolo¬gical malignancy were identified. Conclusion. Port-site metastasis after laparoscopic surgery for urolo¬gical malignancy is rare. The incidence is comparable to the rate for surgical wound metastases.
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Ni S, Tao W, Chen Q, Liu L, Jiang H, Hu H, Han R, Wang C. Laparoscopic versus open nephroureterectomy for the treatment of upper urinary tract urothelial carcinoma: a systematic review and cumulative analysis of comparative studies. Eur Urol 2012; 61:1142-53. [PMID: 22349569 DOI: 10.1016/j.eururo.2012.02.019] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 02/07/2012] [Indexed: 02/06/2023]
Abstract
CONTEXT Laparoscopic nephroureterectomy (LNU) has increasingly been used as a minimally invasive alternative to open nephroureterectomy (ONU), but studies comparing the efficacy and safety of the two surgical procedures are still limited. OBJECTIVE Evaluate the oncologic and perioperative outcomes of LNU versus ONU in the treatment of upper urinary tract urothelial carcinoma. EVIDENCE ACQUISITION A systematic review and cumulative analysis of comparative studies reporting both oncologic and perioperative outcomes of LNU and ONU was performed through a comprehensive search of the Medline, Embase, and the Cochrane Library electronic databases. All analyses were performed using the Review Manager (RevMan) v.5 (Nordic Cochrane Centre, Copenhagen, Denmark) and Meta-analysis In eXcel (MIX) 2.0 Pro (BiostatXL) software packages. EVIDENCE SYNTHESIS Twenty-one eligible studies (1235 cases and 3093 controls) were identified. A significantly higher proportion of pTa/Tis was observed in LNU compared to ONU (27.52% vs 22.59%; p = 0.047), but there were no significant differences in other stages and pathologic grades (all p>0.05). For patients who underwent LNU, the 5-yr cancer-specific survival (CSS) rate was significantly higher, at 9% (p = 0.03), compared to those who underwent ONU, while the overall recurrence rate and bladder recurrence rate were notably lower, at 15% (p = 0.01) and 17% (p = 0.02), respectively. However, there were no statistically significant differences in 2-yr CSS, 5-yr recurrence-free survival (RFS), 5-yr overall survival (OS), 2-yr OS, and metastasis rates between LNU and ONU (all p>0.05). Moreover, there were no significant differences between LNU and ONU in terms of intraoperative complications, postoperative complications, and perioperative mortality (all p>0.05). The results of our study were mainly limited by the retrospective design of most of the individual studies included as well as selection biases based on different management of regional lymph nodes and pathologic characteristics. CONCLUSIONS Our data suggest that LNU offers reliable perioperative safety and comparable oncologic efficacy when compared to ONU. Given that some limitations cannot be overcome, well-designed prospective trials are needed to confirm our findings.
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Affiliation(s)
- Shaobin Ni
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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Ahlawat RK, Gautam G. Suprapubic transvesical single-port technique for control of lower end of ureter during laparoscopic nephroureterectomy for upper tract transitional cell carcinoma. Indian J Urol 2011; 27:190-5. [PMID: 21814308 PMCID: PMC3142828 DOI: 10.4103/0970-1591.82836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Context: Various minimally invasive techniques – laparoscopic, endoscopic or combinations of both - have been described to handle the lower ureter during laparoscopic nephroureterectomy but none has received wide acceptance. Aims: We describe an endoscopic technique for the management of lower end of ureter during laparoscopic nephroureterectomy using a single suprapubic laparoscopic port. Materials and Methods: Transurethral resectoscope is used to make a full thickness incision in the bladder cuff around the ureteric orifice from 1 o’clock to 11 o’clock. A grasper inserted through the transvesical suprapubic port is used to retract the ureter to complete the incision in the bladder cuff overlying the anterior aspect of the ureteric orifice. The lower end of ureter is subsequently sealed with a clip applied through the port. This is followed by a laparoscopic nephrectomy and the specimen is removed by extending the suprapubic port incision. Our technique enables dissection and control of lower end of ureter under direct vision. Moreover, surgical occlusion of the lower end of the ureter prior to dissection of the kidney may decrease cell spillage. The clip also serves as a marker for complete removal of the specimen. Results: Three patients have undergone this procedure with an average follow up of 19 months. Operative time for the management of lower ureter has been 35, 55 and 40 minutes respectively. A single recurrence was detected on the opposite bladder wall after 9 months via a surveillance cystoscopy. There has been no residual disease or any other locoregional recurrence. Conclusions: The described technique for management of lower end of ureter during laparoscopic nephroureterectomy adheres to strict oncologic principles while providing the benefit of a minimally invasive approach.
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Affiliation(s)
- Rajesh K Ahlawat
- Division of Urology and Renal Transplantation, Medanta Kidney and Urology Institute, Medanta, the Medicity, Gurgaon, India
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Janetschek G. Re: Five Year Biochemical Recurrence Free Survival for Intermediate Risk Prostate Cancer After Radical Prostatectomy, External Beam Radiation Therapy or Permanent Seed Implantation. Eur Urol 2011; 59:467. [DOI: 10.1016/j.eururo.2010.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Favaretto RL, Shariat SF, Chade DC, Godoy G, Kaag M, Cronin AM, Bochner BH, Coleman J, Dalbagni G. Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients: are recurrence and disease-specific survival associated with surgical technique? Eur Urol 2010; 58:645-51. [PMID: 20724065 DOI: 10.1016/j.eururo.2010.08.005] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 08/03/2010] [Indexed: 12/24/2022]
Abstract
BACKGROUND Open radical nephroureterectomy (ORN) is the current standard of care for upper tract urothelial carcinoma (UTUC), but laparoscopic radical nephroureterectomy (LRN) is emerging as a minimally invasive alternative. Questions remain regarding the oncologic safety of LRN and its relative equivalence to ORN. OBJECTIVE Our aim was to compare recurrence-free and disease-specific survival between ORN and LRN. DESIGN, SETTING, AND PARTICIPANTS We retrospectively analyzed data from 324 consecutive patients treated with radical nephroureterectomy (RN) between 1995 and 2008 at a major cancer center. Patients with previous invasive bladder cancer or contralateral UTUC were excluded. Descriptive data are provided for 112 patients who underwent ORN from 1995 to 2001 (pre-LRN era). Comparative analyses were restricted to patients who underwent ORN (n=109) or LRN (n=53) from 2002 to 2008. Median follow-up for patients without disease recurrence was 23 mo. INTERVENTION All patients underwent RN. MEASUREMENTS Recurrence was categorized as bladder-only recurrence or any recurrence (bladder, contralateral kidney, operative site, regional lymph nodes, or distant metastasis). Recurrence-free probabilities were estimated using Kaplan-Meier methods. A multivariable Cox model was used to evaluate the association between surgical approach and disease recurrence. The probability of disease-specific death was estimated using the cumulative incidence function. RESULTS AND LIMITATIONS Clinical and pathologic characteristics were similar for all patients. The recurrence-free probabilities were similar between ORN and LRN (2-yr estimates: 38% and 42%, respectively; p=0.9 by log-rank test). On multivariable analysis, the surgical approach was not significantly associated with disease recurrence (hazard ratio [HR]: 0.88 for LRN vs ORN; 95% confidence interval [CI], 0.57-1.38; p=0.6). There was no significant difference in bladder-only recurrence (HR: 0.78 for LRN vs ORN; 95% CI, 0.46-1.34; p=0.4) or disease-specific mortality (p=0.9). This study is limited by its retrospective nature. CONCLUSIONS Based on the results of this retrospective study, no evidence indicates that oncologic control is compromised for patients treated with LRN in comparison with ORN.
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Affiliation(s)
- Ricardo L Favaretto
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY 10065, USA
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Ye J, Ma L, Huang Y, Hou X, Xiao C, Zhao L, Wang G, Hong K, Lu J. Retroperitoneal laparoscopic nephroureterectomy with bladder cuff excision for native upper tract transitional cell carcinoma ipsilateral to a transplanted kidney. Urology 2010; 76:1395-9. [PMID: 20430425 DOI: 10.1016/j.urology.2010.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 11/28/2009] [Accepted: 01/14/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We present preliminary experience of retroperitoneal laparoscopic nephroureterectomy (RPLNU) with bladder cuff excision by combining cystoscopic resection with open transperitoneal dissection for native upper urinary tract transitional cell carcinoma (UUT-TCC) ipsilateral to a transplanted kidney. METHODS Thirteen renal recipients with native UUT-TCC ipsilateral to a transplanted kidney were operated on with RPLNU between November 2005 and August 2008. Retroperitoneal laparoscopic nephrectomy was performed first and followed by cystoscopic excision of ipsilateral ureteral orifice with bladder cuff. A 6-cm midline lower abdominal incision was made. The distal ureter was dissected transperitoneally into the intramural segment, and the intact specimen was removed manually via the same incision. The cystostomy was generally not sutured. RESULTS The mean operation time was 264 minutes. The mean estimated blood loss was 256 mL. Three patients needed blood transfusion. No open conversion was required. Two patients experienced minor complications. Pathologic findings confirmed UUT-TCC in all patients with 8 of the pelvis and 7 of the ureter. Four were involved with bladder TCC. With the mean follow-up of 30 months, none of the patients developed retroperitoneal recurrence or distant metastasis, 2 of the 4 patients with bladder TCC had recurrence in the bladder, and 2 had contralateral UUT-TCC after the first unilateral nephroureterectomy. CONCLUSIONS RPLNU with bladder cuff excision by combining cystoscopic resection with open transperitoneal dissection might be a safe and feasible alternative for native UUT-TCC ipsilateral to a transplanted kidney with acceptable oncological outcomes.
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Affiliation(s)
- Jianfei Ye
- Department of Urology, Peking University Third Hospital, Beijing, China
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[Hand-assisted laparoscopic nephroureterectomy for the treatment of upper urinary tract transitional cancer]. Actas Urol Esp 2009; 33:976-81. [PMID: 19925757 DOI: 10.1016/s0210-4806(09)72896-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report our series of patients undergoing hand-assisted laparoscopic nephroureterectomy (HALNU) using the pluck-off procedure. MATERIALS AND METHODS Twenty patient undergoing HALMU for upper urinary tract urothelial tumors from November 2002 to December 2007 were assessed. Demographic, clinical, surgical, and oncological data were assessed. RESULTS Mean patient age was 69 years. Mean operating time and mean intraoperative bleeding were 176 min and 381 mL respectively. Twenty percent of patients required transfusion of blood products. Conversion to open surgery was not required in any patient. Major and minor complications occurred in 25% and 30% of patients respectively.Mean time to oral intake was 48 hours, and mean hospital stay was 5 days.Pathological study revealed transitional cell carcinoma in all cases: grade I in 5%, grade II in 60%, and grade III in 35% of patients. Clinical stage was pTa in 5%, pT1 in 20%, pT2 in 25%, pT3 in 40%, and pT4 in 10% of patients. A bladder recurrence rate of 30% and a 49% overall survival were seen after a mean follow-up of 33 months (5-73). Six-year cancer-specific survival was 67%. No patient developed either peritoneal or surgical bed recurrence. CONCLUSIONS HALMU using the pluck-off procedure is a feasible, safe, and effective surgery. Both surgical and oncological results are similar to those of open surgery and pure laparoscopy.
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